Brett D Owens

United States Military Academy, West Point, New York, United States

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Publications (161)277.21 Total impact

  • Brett D. Owens
    Clinics in Sports Medicine 10/2014; · 2.38 Impact Factor
  • Article: Dedication
    Clinics in Sports Medicine. 10/2014;
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    ABSTRACT: Snapping scapula syndrome is a rare condition that presents with symptoms ranging from crepitus to disabling pain in the scapulothoracic articulation. This condition may be more frequent in a military population because of physical fitness standards that require nonphysiologic forces to be applied to the scapulothoracic articulation. Nonoperative therapy is the first-line management. Surgical options include arthroscopic or open scapulothoracic bursectomy with or without partial scapulectomy. After scapulothoracic arthroscopy up to 90% of patients report good/excellent results, up to 90% are able to return to work, and more than 60% return to sports.
    Clinics in Sports Medicine. 10/2014;
  • Kenneth L. Cameron, Brett D. Owens
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    ABSTRACT: Because of the volume of sports-related musculoskeletal injuries experienced by military service members, the US Department of Defense has begun to implement the sports medicine model of care to improve the access, efficiency, and effectiveness of care for solders who experience musculoskeletal injuries related to sports and training. In this article, the burden of musculoskeletal injuries and conditions related to sports and physical fitness training within the military is reviewed, and the application of the sports medicine model to care for these injuries in military service members is described.
    Clinics in Sports Medicine. 10/2014; 33(4):573–589.
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    ABSTRACT: A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.
    HSS Journal 10/2014; 10(3):208-12.
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    ABSTRACT: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injury are poorly understood.
    The American journal of sports medicine. 09/2014;
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    ABSTRACT: There has been increased interest in the number of concussions occurring in college football over the past year. In April 2010, the National Collegiate Athletic Association (NCAA) published new guidelines for the diagnosis and treatment of concussions in student athletes.
    Sports Health A Multidisciplinary Approach 09/2014; 6(5):402-5.
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    ABSTRACT: Military personnel have a greater risk of developing osteoarthritis (OA) than the general population. OA is a chronic, painful, and debilitating disease with a high cost burden. Compared with the general population, a higher prevalence of post-traumatic OA has been reported in the military. Using recent literature, we aim to improve the understanding of post-traumatic OA, with an exploration of the pathophysiology of OA. Our review encompasses the current treatment modalities for alleviating the pain from OA with a focus on viscosupplementation. A multimodal approach may be beneficial for the relief of OA pain and improvement of function in military personnel with early OA, and may lower the cost burden.
    Military medicine. 08/2014; 179(8):815-820.
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    AOSSM Annual Meeting, Seattle, WA; 07/2014
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    ABSTRACT: Background: Bone block length for bone–patellar tendon–bone (BPTB) anterior cruciate ligament (ACL) reconstruction has traditionally been 25mm in length. The previous surgical technique did not require the surgeon to pay particular attention to the length of the bone block, and therefore, there is scant evidence in the literature describing ideal lengths. With the gaining popularity of accessory medial portal drilling of the femoral tunnel, concerns with tunnel length and graft shuttling have surfaced. Newer techniques have advised shortening of the femoral bone block to accommodate the shorter tunnel and for ease of bone block manipulation into the aperture of the tunnel. Purpose: To compare the effects of bone block length on the pull-out strength of patellar tendon grafts using metal interference screws in a porcine ACL reconstruction model. The hypothesis was that the pull-out strength of each length of bone block under cyclic and ultimate load to failure testing would surpass the physiologic loads experienced by a normal ACL. Study Design: Controlled laboratory study. Methods: This study used 27 unmatched porcine femurs and BPTB constructs. Specimens were randomly assigned to a 10-, 15-, or 20-mm bone block reconstruction and a cycle load of 100, 500, or 1000 cycles. This resulted in 9 specimen groups with 3 specimens in each group. A central composite design (CCD) for the test matrix was selected, as this was optimum for requiring relatively few experiments while still exploring the complete range of interest for 2 independent variables. Each reconstruction used a 7 � 20–mm titanium interference screw. All reconstructions were performed on the femoral side using 10-mm-wide patellar tendon grafts, and tensile tests were performed. The loading protocol started with a 20-N preload, then cyclic testing to the appropriate number of cycles in the elastic region between 50 and 150 N at a strain rate of 200 mm/min, and then ended with ultimate load-tofailure testing. Ultimate load to failure, peak stress, elongation, and stiffness were all recorded. The patellar tendon graft mode of failure was measured by visual inspection. Results: During load-to-failure testing, 5 of 9 graft constructs in the 10-mmgroup failed at the bone block, while 2 of 9 failed in the 15- mm group at this interface. In the 20-mm group, all 9 specimens failed at the tendon, and none failed at the bone block. There was a statistically significant difference in modes of failure between the bone block length groups in the reconstructed ACL grafts. Analysis indicates that a smaller bone block length graft ismore likely to fail due to a bone block failure than a tendon failure. The average ± standard deviation failure load for all specimenswas 573 ± 171 N.Themean failure loads for the 10-, 15-, and 20-mmgroupswere 614 ± 110, 658 ± 92, and 540 ± 203 N, respectively. There was no statistical significance between the groups in any of these measurements. Conclusion: Bone blocks of 20 to 25mmin length are normally used in surgical practice. Thus, the purpose of this studywas to explore the effects of asmaller boneblock length in the fixation strength of a graft. This study couldnot yielda significant difference in failure load for differently sized bone blocks. There was a significant tendency of shorter bone block lengths to fail due to bone block failure. Clinical Relevance: Bone block failure was defined as slippage of the bone block or interference screw. These results show that using a smaller bone block may increase the likelihood of a graft failure in an ACL reconstruction. Keywords: ACL reconstruction; BTB autograft; interference screw fixation
    Orthopaedic Journal of Sports Medicine. 05/2014; 2(2).
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    ABSTRACT: BACKGROUND:A medial collateral ligament (MCL) knee sprain is a prevalent injury in athletic populations that may result in significant time lost to injury. Remarkably little is known of the epidemiology of this injury. PURPOSE:To define the incidence of MCL tears and to determine the demographic and athletic risk factors. STUDY DESIGN:Descriptive epidemiological study. METHODS:A longitudinal cohort study was performed to examine the epidemiology of isolated MCL sprains at the United States Military Academy (USMA) between 2005 and 2009. Charts and radiographic studies were reviewed by an independent orthopaedic surgeon to identify all new isolated MCL sprains resulting in time lost to sport and activity that occurred within the study period. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated per 1000 person-years at risk and by sex, sport, and level of competition. The IR per 1000 athlete-exposures (AEs) was also determined. Incidence rate ratios (IRRs) and respective 95% CIs were calculated between male and female students, intercollegiate and intramural athletes, and male and female intercollegiate athletes involved in selected sports. Chi-square and Poisson regression analyses were used to examine the relationship between the variables of interest and the incidence of MCL sprains, with statistical significance set at P < .05. RESULTS:A total of 128 cadets sustained isolated MCL injuries during 17,606 student person-years from 2005 to 2009. This resulted in an IR of approximately 7.3 per 1000 person-years. Of the 128 injuries, 114 were in male athletes (89%) and 14 were in female athletes (11%). Male cadets had a 44% higher IR than did female cadets (7.60 vs 5.36, respectively), although this was not significant (P = .212). Of 5820 at-risk intercollegiate athletes, 59 (53 male, 6 female) sustained an isolated MCL sprain during 528,523 (407,475 male, 121,048 female) AEs for an overall IR of 10.14 per 1000 person-years and 0.11 per 1000 AEs. The IRR of MCL sprains of men compared with women involved in intercollegiate athletics was 2.87 (95% CI, 1.24-8.18) per 1000 person-years and 2.62 (95% CI, 1.13-7.47) per 1000 AEs. Of 21,805 at-risk intramural athletes, with quarterly participation, 16 (all male) sustained isolated MCL injuries during 225,683 AEs for an overall IR of 0.07 per 1000 AEs. The IRs of MCL injuries of intercollegiate and intramural athletes did not differ significantly. In intercollegiate sports, wrestling (0.57), judo (0.36), hockey (0.34), and rugby (men's, 0.22; women's, 0.23) had the highest IRs per 1000 AEs. When examining men's intercollegiate athletics, the IRRs of wrestling (13.41; 95% CI, 1.80-595.27) and hockey (8.12; 95% CI, 0.91-384.16) were significantly higher compared with that of lacrosse. Among women's intercollegiate sports as well as intramural sports, there were no significant differences in IRs. A median of 16 days was lost to injury, with 2407 total days lost for all injuries. Grade 1 MCL injuries lost a median of 13.5 days, while higher grade injuries lost a median of 29 days. CONCLUSION:Medial collateral ligament injuries are relatively common in athletic cohorts. The most injurious sports are contact sports such as wrestling, hockey, judo, and rugby. Male athletes are at a greater risk than female athletes. Intercollegiate athletes are at a greater risk than intramural athletes. The average amount of time lost per injury was 23.2 days, with greater time lost with higher grade sprains than grade 1 sprains.
    The American journal of sports medicine 03/2014; · 3.61 Impact Factor
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    ABSTRACT: To quantify the rate of surgical failure after anterior shoulder stabilization procedures, as well as to identify demographic and surgical risk factors associated with poor outcomes. All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability were isolated from the Military Health System Management Analysis and Reporting Tool between 2003 and 2010. Demographic variables (age, gender) and surgical variables (treatment facility volume, admission status, surgical technique) were extracted. Rates of surgical failure, defined as subsequent revision surgery or medical discharge with persistent shoulder complaints, were recorded from the electronic medical record and US Army Physical Disability Agency database. Risk factor analysis was performed with univariate t tests, χ(2) tests, and a multivariable logistic regression model with failure as the outcome. A total of 3,854 patients underwent Bankart repair during the study period, with most procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent revision stabilization whereas 339 patients (8.8%) were medically discharged with complaints of shoulder instability, for a total combined failure rate of 13.8% (n = 532). Univariate analyses showed no significant effect for gender; however, younger age, higher facility volume, open repair, and inpatient status were significant factors associated with subsequent surgical failure. Multivariable analyses confirmed that young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery. Young age remains a significant risk factor for surgical failure after Bankart repair. Patients who underwent arthroscopic Bankart repair had a significantly lower surgical failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%). Despite advances in surgical technique, 1 in 20 military service members required revision surgery after failed primary stabilization in this study. Level IV, therapeutic case series.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2014; 30(2):172-7. · 3.10 Impact Factor
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    Brett D Owens
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    ABSTRACT: Where Are We Now?Early treatment of first-time anterior glenohumeral dislocations still elicits controversy and active investigation. In 2001, Itoi and colleagues [3] introduced the concept of bracing in external rotation with increased tension of the subscapularis resulting in a coaptation of the avulsed capsulolabral complex back to its bony bed, which allowed for healing in a reduced position. After showing proof of concept with an MRI study [3], this group moved forward with randomized trials comparing external rotation bracing for 3 weeks, with 3 weeks in a standard internal rotation sling [1, 2]. Their initial trial enrolled 40 patients with a mean age of 39 years (range 17 to 84 years) and found a significant reduction in recurrent dislocation in the external rotation group [1]. A subsequent trial included randomized 198 patients representing a slightly younger cohort (mean ages 35 and 37 years), and had similar findings [2]. The authors included a subgroup analysis, and found t
    Clinical Orthopaedics and Related Research 02/2014; · 2.79 Impact Factor
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    ABSTRACT: Purpose To quantify the rate of surgical failure after anterior shoulder stabilization procedures, as well as to identify demographic and surgical risk factors associated with poor outcomes. Methods All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability were isolated from the Military Health System Management Analysis and Reporting Tool between 2003 and 2010. Demographic variables (age, gender) and surgical variables (treatment facility volume, admission status, surgical technique) were extracted. Rates of surgical failure, defined as subsequent revision surgery or medical discharge with persistent shoulder complaints, were recorded from the electronic medical record and US Army Physical Disability Agency database. Risk factor analysis was performed with univariate t tests, χ2 tests, and a multivariable logistic regression model with failure as the outcome. Results A total of 3,854 patients underwent Bankart repair during the study period, with most procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent revision stabilization whereas 339 patients (8.8%) were medically discharged with complaints of shoulder instability, for a total combined failure rate of 13.8% (n = 532). Univariate analyses showed no significant effect for gender; however, younger age, higher facility volume, open repair, and inpatient status were significant factors associated with subsequent surgical failure. Multivariable analyses confirmed that young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery. Conclusions Young age remains a significant risk factor for surgical failure after Bankart repair. Patients who underwent arthroscopic Bankart repair had a significantly lower surgical failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%). Despite advances in surgical technique, 1 in 20 military service members required revision surgery after failed primary stabilization in this study. Level of Evidence Level IV, therapeutic case series.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2014; 30(2):172–177. · 3.10 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2014; 30(6):e2. · 3.10 Impact Factor
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    ABSTRACT: Shoulder pathology, particularly SLAP (superior labrum anterior-posterior) lesions, is prevalent in overhead athletes and physically active individuals. The aim of this study is to quantify the burden of SLAP lesions in the military and establish risk factors for diagnosis. A retrospective analysis of all service members diagnosed with a SLAP lesion (International Classification of Disease, Ninth Revision code 840.70) in the Defense Medical Epidemiological Database between 2002 and 2009 was performed. Available epidemiological risk factors including age, sex, race, military rank, and branch of service were evaluated using multivariate Poisson regression analysis, and cumulative and subgroup incidence rates were calculated. During the study period, approximately 23,632 SLAP lesions were diagnosed among a population at risk of 11,082,738, resulting in an adjusted incidence rate of 2.13 per 1,000 person-years. The adjusted annual incidence rate for SLAP lesions increased from 0.31 cases per 1,000 person-years in 2002 to 1.88 cases per 1,000 person-years in 2009, with an average annual increase of 21.2 % (95 % CI 20.7 %, 22.0 %, p < 0.0001) during the study period. Age, sex, race, branch of military service, and military rank were independent risk factors associated with the incidence rate of SLAP lesion (p < 0.01). Male service members were over twofold more likely (IRR, 2.12; 95 % CI 2.01, 2.23) to sustain a SLAP lesion when compared with females. Increasing age category was associated with a statistically significant increase in the incidence rate for SLAP lesions in the present study (p < 0.001). After controlling for the other variables, those individuals of white race, enlisted ranks, or Marine Corps service experienced the highest incidence rates for SLAP. This is the first study to establish the epidemiology of SLAP lesions within an active military cohort in the American population. Sex, age, race, military rank, and branch of military service were all independently associated with the incidence rate of SLAP lesions in this physically active population at high risk for shoulder injury. LEVEL OF EVIDENCE: II.
    Knee Surgery Sports Traumatology Arthroscopy 12/2013; · 2.68 Impact Factor
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    ABSTRACT: Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year-old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete. A 19-year-old military cadet and competitive judo athlete reported to a direct-access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction. Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post-operation. Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population. 4.
    International journal of sports physical therapy. 12/2013; 8(6):862-70.
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    ABSTRACT: Several studies have focused on management of shoulder instability in the adolescent and young adult population. However, a paucity of literature exists regarding shoulder dislocation in the skeletally immature population. The presence of an open physis makes the dislocated pediatric shoulder a challenging clinical problem. In general, management includes prompt reduction and sling immobilization. In athletic patients aged ≥14 years with a Bankart lesion, early surgical intervention may be warranted because of the higher risk of recurrent instability. However, the literature on younger skeletally immature patients is less clear in terms of risk of further instability and the necessity of surgical intervention. In the skeletally immature population, a relatively low rate of recurrent instability after primary dislocation has been reported in the recent literature. Surgical intervention should be considered for patients with recurrent instability.
    The Journal of the American Academy of Orthopaedic Surgeons 09/2013; 21(9):529-537. · 2.46 Impact Factor
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    Sports Health A Multidisciplinary Approach 09/2013; 5(5):400-1.
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    ABSTRACT: BACKGROUND:While posterior glenohumeral instability is becoming increasingly common among young athletes, little is known of the risk factors for injury. PURPOSE:To determine the modifiable and nonmodifiable risk factors for posterior shoulder instability in a high-risk cohort. STUDY DESIGN:Case-control study (prognosis); Level of evidence, 2. METHODS:A prospective cohort study in which 714 young athletes were followed from June 2006 through May 2010 was conducted. Baseline testing included a subjective history of instability, instability testing by a sports medicine fellowship-trained orthopaedic surgeon, range of motion, strength measurement with a handheld dynamometer, and bilateral noncontrast magnetic resonance imaging of the shoulder. A musculoskeletal radiologist measured glenoid version, height, depth, rotator interval (RI) height, RI width, RI area, and RI index. Participants were followed to document all acute posterior shoulder instability events during the 4-year follow-up period. The time to the posterior shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariable Cox proportional hazards regression models were used to analyze the data. RESULTS:Complete data on 714 participants were obtained. During the 4-year surveillance period, 46 shoulders sustained documented glenohumeral instability events, of which only 7 were posterior in direction. The baseline factors that were associated with subsequent posterior instability during follow-up were increased glenoid retroversion (P < .0001), increased external rotation strength in adduction (P = .029) and at 45° of abduction (P = .015), and increased internal rotation strength in adduction (P = .038). CONCLUSION:This is the largest known prospective study to follow healthy participants in the development of posterior shoulder instability. Posterior instability represents 10% of all instability events. The most significant risk factor was increased glenoid retroversion. While increased internal/external strength was also associated with subsequent instability, it is unclear whether these strength differences are causative or reactive to the difference in glenoid anatomy. This work confirms that increased glenoid retroversion is a significant prospective risk factor for posterior instability.
    The American journal of sports medicine 08/2013; · 3.61 Impact Factor

Publication Stats

1k Citations
277.21 Total Impact Points

Institutions

  • 2008–2014
    • United States Military Academy
      • Department of Mathematical Sciences
      West Point, New York, United States
  • 2006–2014
    • Keller Army Community Hospital
      West Point, New York, United States
  • 2011–2013
    • Tripler Army Medical Center
      Honolulu, Hawaii, United States
    • Brooke Army Medical Center
      Houston, Texas, United States
  • 2009–2013
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
    • United States Army
      Washington, West Virginia, United States
  • 2012
    • Pennsylvania State University
      • Department of Kinesiology
      University Park, MD, United States
  • 2001–2012
    • Walter Reed National Military Medical Center
      • Division of Orthopaedic Surgery
      Washington, Washington, D.C., United States
  • 2009–2011
    • University of Colorado
      • Department of Orthopaedics
      Denver, CO, United States
  • 2010
    • The University of Arizona
      • College of Medicine
      Tucson, AZ, United States
  • 2006–2009
    • U.S. Army Institute of Surgical Research
      Houston, Texas, United States
  • 2002–2007
    • University of Massachusetts Medical School
      Worcester, Massachusetts, United States
  • 2003
    • University of Massachusetts Amherst
      Amherst Center, Massachusetts, United States
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States